Three-dimensional facial imaging: accuracy and considerations for clinical applications in orthodontics

This study determined the accuracy of a camera system capable of recording three-dimensional facial images. A Rainbow 3D Camera Model 250 system (Genex Technologies Inc, Kensington, Md) was used to capture images of specific models: (1) a precalibrated precision model and (2) a mannequin model that served to simulate the human condition. To assess the accuracy of the camera system, repeated images of both models were recorded at two time points, one week apart. Repeated measurements of specific distances were recorded directly on the models and from each image. Means and standard deviations were calculated for all the repeated measurements at each time point. A two-tailed t-test was used to test for significant differences between (1) each distance measured directly on the precision model and the same distance measured on the images of the precision model, (2) each distance measured directly on the mannequin and the same distance measured on the images of the mannequin, and (3) the mean differences between the same distances measured at the two times. The findings showed that substantial image distortion occurred when images of sharp angles (90 degrees) were captured. Also, those images captured from the frontal perspective +/- 15 degrees were the most accurate.     

Extraskeletal Ewing's sarcoma of the larynx

Primitive neuroectodermal tumour/extraskeletal Ewing's sarcoma (PNET/EES) is a rare disease of the head and neck region. We report a case of a 74-year-old man with a laryngeal Ewing's sarcoma. This is the first reported case of extraskeletal Ewing's sarcoma of the larynx in an elderly male patient. The patient was successfully treated with surgical resection and post-operative radiotherapy.     

An infant with pentalogy of Cantrell and limb defects diagnosed prenatally

We present a case of pentalogy of Cantrell which was diagnosed prenatally on routine ultrasound examination. There were several associated limb defects. We discuss the differential diagnosis and conclude that our case probably had a variant form of this syndrome.     

Transarterial chemo-lipiodolization can reactivate hepatitis B virus replication in patients with hepatocellular carcinoma

BACKGROUND/AIMS: Reactivation of hepatitis B virus (HBV) replication is a well-known complication in cancer patients receiving chemotherapy. The aims of this study were to determine the incidence of HBV reactivation in hepatocellular carcinoma (HCC) patients undergoing transarterial chemo-lipiodolization, and to clarify factors contributing to HBV reactivation. METHODS: From April 2001 to September 2002, 146 HBsAg positive patients newly diagnosed as HCC were enrolled in the study. Among these, 83 patients underwent transarterial chemo-lipiodolization using epirubicin and/or cisplatin, and 63 received other treatments. RESULTS: In total, HBV reactivation occurred in 30 (20.5%) patients (28 with chemo-lipiodolization and 2 with other treatments), and of the 30 patients, 19 (13.0%) (18 with chemo-lipiodolization and 1 with other treatments) developed hepatitis. Chemo-lipiodolization was significantly correlated with a higher incidence of hepatitis attributed to HBV reactivation than other treatments (21.7% vs. 1.6%, P<0.001), irrespective of HBeAg or HBV DNA. Among 83 patients undergoing chemo-lipiodolization, HBV reactivation occurred in 28 (33.7%) patients, and HBeAg seropositivity was the only independent predictor of HBV reactivation (P=0.013). Three (10.7%) of them died of hepatic decompensation resulting from HBV reactivation. CONCLUSIONS: Transarterial chemo-lipiodolization can reactivate HBV, and HBeAg-positive HCC patients receiving chemo-lipiodolization should be closely monitored for HBV reactivation.     

Gastric adenocarcinoma after renal transplantation

BACKGROUND/AIMS: Little is known of the characteristics of gastric adenocarcinoma after renal transplantation. This study was performed to find out the incidence and clinicopathological features of gastric adenocarcinoma after renal transplantation in an endemic area for gastric cancer. METHODOLOGY: Between April 1979 and March 2001, fourteen gastric adenocarcinoma patients (0.7%) out of 2000 renal transplant recipients in a single institute were retrospectively reviewed. RESULTS: Gastric adenocarcinoma was identified in 14 recipients (8 males and 6 females; mean age 47.6 years) about 60 months after renal transplantation. Four patients had early gastric cancer; ten patients had cancer in an advanced stage. Eleven patients underwent surgical resection, while three with distant metastasis were treated symptomatically. There was no postoperative mortality. Seven patients survived without evidence of recurrence, whereas four died of recurrence and three of gastric cancer progression. CONCLUSIONS: Renal transplant recipients are at increased risk of gastric adenocarcinoma, the most common malignancy in Korea. With curative surgery, favorable prognosis can be anticipated when the diagnosis is made at an early stage. Regular endoscopic examination for early diagnosis is recommended during the follow-up period after renal transplantation in a gastric cancer endemic area.     

Lymphangioma of the esophagus: surgical treatment

Lymphangioma of the esophagus is a very rare submucosal tumor, but it can usually be removed without complication by endoscopic resection because of its small size and benign nature. My colleagues and I report a case of an uncommonly large lymphangioma (5.1 x 2.3 x 1.7 cm) in the distal esophagus treated by distal esophagectomy and esophagogastrostomy for complete resection without narrowing the esophagus. The patient's immediate postoperative course was uneventful, and he remains well 6 months after the operation.     

Detection and characterization of focal hepatic lesions: mangafodipir vs. superparamagnetic iron oxide-enhanced magnetic resonance imaging

PURPOSE: To compare the mangafodipir-enhanced magnetic resonance (MR) and superparamagnetic iron oxide (SPIO)-enhanced images for their ability to detect and characterize focal hepatic lesions. MATERIALS AND METHODS: Unenhanced, mangafodipir-enhanced, and SPIO-enhanced hepatic MR images obtained from 64 patients were analyzed. A total of 121 hepatic lesions were included: 66 hepatocellular carcinomas (HCCs), 26 metastases, 14 hemangiomas, 5 cysts, 3 cholangiocarcinomas, 4 focal nodular hyperplasias (FNHs), 2 abscesses, and 1 adenoma. Two radiologists independently reviewed the two sets of images in a random order: 1) the unenhanced and mangafodipir-enhanced images (the mangafodipir set) and 2) the unenhanced and SPIO-enhanced images (the SPIO set). This study compared the accuracy of lesion detection, the ability to distinguish between a benign and malignant lesion, and the ability to distinguish between the hepatocellular and nonhepatocellular origins of the lesions using the areas (Az) under the receiver operating characteristic (ROC) curve. RESULTS: The overall accuracy for detecting focal lesions was significantly higher (P < 0.05) with the SPIO set (Az = 0.846 and 0.871 for readers 1 and 2, respectively) than with the mangafodipir set (Az = 0.716 and 0.766). Most of the lesions detected only with the SPIO-enhanced MR images by the readers were small HCCs. For lesions larger than 15 mm, the sensitivities of the two contrast enhancement techniques were similar for both readers. The accuracy of the mangafodipir and SPIO sets in distinguishing between benign and malignant lesions was comparable. The accuracy for distinguishing between the hepatocellular and nonhepatocellular origins of the lesions was significantly higher (P < 0.05) using the mangafodipir set (Az = 0.897 and 0.946) than using the SPIO set (Az = 0.741 and 0.833). CONCLUSION: SPIO- and mangafodipir-enhanced images were comparable for detection of focal hepatic lesions other than small HCCs, which were better detected on the SPIO-enhanced images. Mangafodipir-enhanced images are likely better than the SPIO-enhanced images for distinguishing between focal liver lesions with a hepatocellular or nonhepatocellular origin.     

Non-Infectious Ischiogluteal Bursitis: MRI Findings

Objective

We wished to report on the MRI findings of non-infectious ischiogluteal bursitis.

Materials and Methods

The MRI findings of 17 confirmed cases of non-infectious ischiogluteal bursitis were analyzed: four out of the 17 cases were confirmed with surgery, and the remaining 13 cases were confirmed with MRI plus the clinical data.

Results

The enlarged bursae were located deep to the gluteus muscles and postero-inferior to the ischial tuberosity. The superior ends of the bursal sacs abutted to the infero-medial aspect of the ischial tuberosity. The signal intensity within the enlarged bursa on T1-weighted image (WI) was hypo-intense in three cases (3/17, 17.6%), iso-intense in 10 cases (10/17, 58.9%), and hyper-intense in four cases (4/17, 23.5%) in comparison to that of surrounding muscles. The bursal sac appeared homogeneous in 13 patients (13/17, 76.5%) and heterogeneous in the remaining four patients (4/17, 23.5%) on T1-WI. On T2-WI, the bursa was hyper-intense in all cases (17/17, 100%); it was heterogeneous in 10 cases and homogeneous in seven cases. The heterogeneity was variable depending on the degree of the blood-fluid levels and the septae within the bursae. With contrast enhancement, the inner wall of the bursae was smooth (5/17 cases), and irregular (12/17 cases) because of the synovial proliferation and septation.

Conclusion

Ischiogluteal bursitis can be diagnosed with MRI by its characteristic location and cystic appearance.     

Age-Related Changes in Conventional and Magnetization Transfer MR Imaging in Elderly People: Comparison with Neurocognitive Performance

Objective

This study was designed to compare three different measures of the elderly human brain; the magnetization transfer ratio (MTR) histogram, the percentage of brain parenchymal volume, and the volume of T2 hyperintense areas in terms of correlations with the study subjects'' neurocognitive performance.

Materials and Methods

Thirty-five healthy community-dwelling elderly volunteers aged 60-82 years underwent dual fast spin-echo (FSE) imaging and magnetization transfer imaging. A semi-automated technique was used to generate the MTR histogram, the brain parenchymal volume, and the T2 lesion volume. The subjects'' neurocognitive performance was assessed by using the Korean-Mini Mental State Examination (K-MMSE) and additional tests. The peak height of the MTR (PHMTR), the percentage of brain parenchymal volume (PBV), and the normalized T2 lesion volume (T2LV) were compared between the normal group (Z score on the K-MMSE ≥ -2, n=23) and the mild cognitive impairment group (Z score on the K-MMSE < -2, n=12), and these parameters were correlated with age and various neurocognitive performance scores.

Results

The PHMTR was significantly lower in the cognitively impaired subjects than the PHMTR in the normal subjects (p = 0.005). The PBV scores were lower in the cognitively impaired subjects than in the normal subjects (p = 0.02). The T2LV scores were significantly higher in the cognitively impaired subjects (p = 0.01). An inverse correlation was found between the PHMTR and T2LV (r = -0.747, p < 0.001), and also between the PBV and T2LV (r = -0.823, p < 0.001). A positive correlation was observed between the PHMTR and the PBV (r = 0.846, p < 0.001). Scores on the various neurocognitive tests were positively correlated with the PHMTR (6 of 7 items) and the PBV (5 of 7 items), and they were negatively correlated with the T2LV (5 of 7 items).

Conclusion

Our findings of a correlation among the PBV, the T2LV, and the PHMTR suggest that MTR histograms and the PBV and T2LV can be used as a reliable method and valid statistical tool, respectively, for quantifying the total lesion burden in an aging brain.